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. 2025 May 21;22(5):810.
doi: 10.3390/ijerph22050810.

Hearing Impairment Among Drug-Resistant Tuberculosis Patients in Rural Eastern Cape: A Retrospective Analysis of Audiometric Findings

Affiliations

Hearing Impairment Among Drug-Resistant Tuberculosis Patients in Rural Eastern Cape: A Retrospective Analysis of Audiometric Findings

Lindiwe Modest Faye et al. Int J Environ Res Public Health. .

Abstract

Hearing loss (HL) is a major global health concern, with drug-induced ototoxicity contributing significantly, particularly in patients undergoing treatment for drug-resistant tuberculosis (DR-TB). In South Africa, where both TB and HIV are prevalent, the risk of treatment-related auditory damage is especially high. This study aimed to assess the prevalence and predictors of hearing impairment among DR-TB patients in rural Eastern Cape, South Africa. A retrospective analysis was conducted on 438 DR-TB patients treated between 2018 and 2020, using pure tone audiometry (PTA) to assess hearing status post-treatment. Demographic, clinical, and lifestyle data were extracted from patient records and analyzed using logistic regression. The overall prevalence of hearing loss was 37.2%. Risk was significantly associated with an older age, a male gender, DR-TB classification (MDR, pre-XDR, and XDR), unsuccessful treatment outcomes, and substance use. Prevalence of HL increased notably in patients aged 70 and older. Lifestyle factors, particularly combined use of tobacco, alcohol, and drugs, were linked to higher odds of HL. These findings underscore the need for routine audiometric screening and personalized treatment monitoring in DR-TB care, especially for high-risk populations. Early identification of ototoxicity risk factors can inform safer treatment regimens and improve patient outcomes in resource-limited settings.

Keywords: adverse drug reaction; audiometric assessment; drug-resistant tuberculosis; hearing loss; ototoxicity; pure tone audiometry.

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Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 3
Figure 3
Distribution of audiometry results by treatment outcome among DR-TB patients (n = 438). Bar heights represent the number of patients per treatment outcome category. Each bar is divided by hearing status (positive = hearing loss, negative = no hearing loss). For the purpose of comparison in Figure 4, treatment outcomes were grouped as follows: ‘Cured’ and ‘Treatment Completed’ were classified as successful, while ‘Treatment Failed’, ‘Died’, ‘Lost to Follow-Up (LTFU)’, ‘Moved Out’, ‘Transferred Out’, and ‘Still on Treatment’ were grouped as unsuccessful outcomes. (Treatment outcomes: 1.0 = cured; 2.0 = treatment completed; 3.0 = LTFU; 4.0 = treatment failed; 5.0 = died; 6.0 = moved out; 7.0 = transferred out; and 8.0 = still on treatment).
Figure 4
Figure 4
Comparison of audiometry results in successful versus unsuccessful treatment outcomes.
Figure 1
Figure 1
Age distribution of patients.
Figure 2
Figure 2
Gender distribution of DR-TB patients included in the final analysis (n = 438, excluding 18 patients with incomplete audiometric data).
Figure 5
Figure 5
Distribution of audiometry results stratified by DR-TB type.
Figure 6
Figure 6
Comparison of audiometry results stratified by HIV status.

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